Outline

Objective

The introduction of „Diagnosis-related Groups (DRG)“ leads to significant changes, e.g. largely increasing documentation duties. Hence, administrational, but not medical needs, play a major role. This and the force to establish these tasks without additional resources, causes relevant dissatisfaction of the medical personal.

Methods

Parallel to the establishment of a computerized clinical workplace system (KAS), each unit of the neurosurgical service was equipped with a DRG-assistant: one examined documentation specialist, and 2 nurses, who underwent special education and qualification (mibeg-Institut Medizin, KÃ¶ln). These DRG-assistants are financed by 2/3 from the doctors pool, and by 1/3 from the nursing pool. We excluded the intensive-care unit, because there an immediate documentation is provided by the nurses and doctors on duty.

Results

1. The implementation of a computerized KAS requires a significant adaptation of clinical routines, e.g. patient discharges, a multilevel control of coding, etc. Workflow became more transparent, but also controllable. Additional working time had to be invested, approximately one hour per doctor and day.

2. After educating and training the DRG-assistants, we recognized an obvious support for the doctors. The coding is done with the aid of documented medical history, patients files, surgical reports, and the discharge letter. In the end, the codes are verified and signed by a medical doctor, so that the legal aspects are respected. The DRG-assistants also support the doctors regarding organization and administration on the respective wards.

Conclusions

With these structural changes we were able to diminish the work-load for the medical personal. This lead to a plus of satisfaction, in spite of the reduction of personal by one doctor and one nurse. However, control of the coding by DRG-assistants and of newly established algorithms requires permanent doctoral engagement, too.